Community Mental Health

We plan to change the way we provide community mental health services for adults and older people across Leeds.
Our service users will still get high quality services and support and, in the main, they may not see significant changes – it’s the way we organise ourselves to give the care and support that is changing.

2 October 2018 Update from Andy Weir, Chair of the Community Redesign Project Board and Deputy Chief Operating Officer

We are now able to share our Engagement Report which summarises the feedback we received from services users , their families and carers; our workforce and health and social care organisations and the third sector in Leeds about our plans to change the way we deliver Community Mental Health Services in Leeds. You can also find out more in Healthwatch’s report.

We’ve learned so much from our engagement and started a conversation with local people that we will certainly continue in future.

We are now beginning the journey that will see the new service models go live in March 2019. There will be lots of work on the fine detail, along with a programme of staff training and development. We will develop a formal evaluation and review process, which will allow us to quickly pick up any issues from implementation.

We will continue to listen and take feedback on board as we implement and evaluate our new service models. We have some good channels in place for this, but we also know we need to make improvements to the way we engage our public and service users. We’re very serious about this and have commissioned Leeds Beckett University to review our approach to public engagement and patient experience and look at how we gather, use and act on the feedback we get. The review included interviews with a range of stakeholders and we are expecting the final report soon and will share what we learn.

Care will always be based on a thorough assessment of each individual’s circumstances and needs.

Service users will be at the centre of their care and have seamless services delivered by teams made up of different professionals

Care will always be about recovery – for people with dementia this is about living well with the condition

Each person will be seen by clinical staff who have the necessary skills, values and attitudes to provide high quality support. They will be knowledgeable about mental health and other difficulties and their effects in different stages of life

We will work closely with other organisations that can offer support to service users

Hospital will be a last resort and only for the people who are most unwell. We will aim to get services users out of hospital as quickly as we can so they can recover at home or in another care setting.

Why change?

Some of our community mental health services have grown to meet increasing demand. Trying to meet everyone’s needs has led to a situation where we’re not always making best use of our staff’s expertise. We are doing the same thing as some other service providers in the city and sometimes people get a different type of service depending on where they live. We don’t think this is right or fair.

A previous service reorganisation into an ‘ageless’ service hasn’t worked well for older people (65 plus). They have found it harder to get support from us at times when they were really distressed. We have also lost staff who wanted to be dedicated to working with older people’s services.

There’s growing demand for services because:

more people are finding life tough and developing mental ill health

the knock-on from the crisis in adult social care – if care needs are not met, distress levels increase

Pressure on primary care means people no longer have a relationship with a single family doctor for ‘talking things through’

Our plans for change will help focus our support on the people who need it most. We know we can’t do everything and we will be working closely with other providers and partners to have more joined up community mental health services across the city.

Since 2012 our community mental health services have worked with all adult age groups. We hoped that this would help us to meet the ever increasing demands for older people’s services. Feedback from our staff and our service users and carers tells us that our services don’t feel responsive enough to the needs of older adults.

We also know that there are differences in the way our service works in different parts of the city and moving between different teams within our service can be difficult.

The changes we’re making

We plan to create a separate older people’s community mental health service. Having a dedicated service will allow us to recognise and respond better to the mental health and dementia-related difficulties of those in later life. As far as possible, the service will be the same wherever people live in the city.

The new older people’s service will include community mental health teams, memory assessment services and an intensive home treatment team. Having these dedicated teams will allow our staff to focus their expertise on older people’s needs, so that the people who use our services can feel confident that they will get high quality care. The teams will include a variety of professionals working together such as nurses, occupational therapists, psychiatrists, psychologists, health support workers and other specialisms like physiotherapy, pharmacy, dietetics and speech and language therapy when needed.

Improving our memory assessment service

We will provide rapid access to assessment and diagnosis and will give appropriate treatment and short-term support based on what the service user and their carers needs. The service will work closely with organisations that offer ongoing support to people with memory problems and there will be a separate service for younger people with dementia.

Providing an Intensive Home Treatment Team

This team will provide care, treatment and support for people with the most intensive mental health, dementia and complex frailty needs for up to six weeks. This support will mostly be offered wherever the service user lives. During this time our team of experts will be working with the service user, their carers and other providers to identify a care package that meets the individual’s future needs.

The benefits

More contact with the support team who are dedicated to working with older people

Better continuity of care between different parts of our service

More home-based treatment that offers a genuine alternative to hospital admission

Inpatient and community services are more joined up

More shared and joined up care between our mental health service and other organisations in the city

Decisions about care and admission to hospital being made in a consistent way

Since 2012 our three community mental health teams have worked with all age groups. We hoped that this would help us to meet the ever increasing demands for our services. Feedback from our staff and our service users and carers tells us that this service model isn’t working very well for anyone and it’s patchy across the city.

The changes we’re making

We want to develop a citywide community adult service which combines crisis assessment and intensive support for service users with complex needs.

People will be assessed quickly and will be offered home-based care and support as a genuine alternative to hospital admission. This is important because we know people recover better when they’re at home.

We will take up to six weeks for assessment. This will allow the experts in a community mental health team to get to know the service users and work with them and their carers to develop a personalised treatment plan. This plan is a service user’s journey to better health and will include an agreement of what ‘good’ looks like and an ‘end point’ for our services.

Care will be delivered by a team of experts working together to ‘wrap around’ the service users. This might include support from other NHS services or from community partners who can better meet the service users’ needs. Service users will often have a care co-ordinator who will offer care and support and will speak to others on service users’ behalf.

The benefits

More contact with the community mental health team

Services that are easier to understand and move between

More home-based treatment that offers a genuine alternative to hospital admission

Inpatient and community services are more joined up

More shared and joined up care between our mental health service and other organisations in the city

Decisions about care and admission to hospital being made in a consistent way

One in four adults will have a mental health need at some point in their lives.

The Leeds in Mind 2017 – Mental Health Needs Assessment, which was published in October 2017, tells us that an estimated 106,000 people in Leeds will experience a Common Mental Health Disorder (CMHD) such as anxiety and depression every year. Gaps in local data suggest under-reporting of mental ill health amongst older people, with only a third of older people with depression ever discussing it with their GP

Nearly 8,000 people are recorded as having a Serious Mental Illness (SMI) in primary care in Leeds. Poverty, deprivation, chronic ill health, physical disability and adverse life events all increase the risk of poor mental health.

The number of people with a dementia diagnosis was 6,219 (167 in under 65s).

Mental health problems can lead to social isolation and exclusion, with mental health stigma being seen as a high risk factor. Stigma can become a significant barrier to people developing an understanding of mental health difficulties and to accessing treatment.

Physical health problems is another significant risk factor for developing mental health problems in later life and more than one in three people in Leeds have at least one long term condition. There is a clear link between having a serious mental illness and long term conditions such as diabetes, Chronic Obstructive Pulmonary Disease (COPD) and hypertension.

We have a responsibility to use our skills and expertise to work with those people who can best benefit from them. This includes when people experience acute episodes of extreme distress. We want care to be delivered as close to the individual’s community as possible, so they don’t have to go out of Leeds to receive the support they need. At times, people may want or need to be in an inpatient service. We also want to support people when they are managing the significant transitions from inpatient services to sustained and supported community living.